Yoshioka N, Tominaga S, Inui T
Department of Plastic and Reconstructive Surgery, Osaka City University, Japan.
Surg Neurol. 1996 Nov;46(5):430-5; discussion 435-6. doi: 10.1016/s0090-3019(96)00195-4.
Use of the omentum in the treatment of moyamoya disease is now widely accepted, and, especially in patients with ischemic symptoms of anterior or posterior cerebral artery distribution, omental transplantation or other indirect revascularizations are indicated.
A 39-year-old man, who developed left homonymous hemianopia, was discovered to have occlusion of the distal portion of bilateral internal carotid arteries. We performed indirect revascularization with an omental flap on the left cerebral hemisphere and a serratus anterior muscle flap on the right cerebral hemisphere.
Subsequent clinical course was uneventful. Cerebral blood flow study and angiography revealed good collateral circulation in both the omentum and muscle flap. The collateral circulation was more developed than that arising from the omental transfer on the contralateral side at the same postoperative period.
This type of encephalomyosynangiosis (EMS)-EMS with free muscle flap-is as effective as that with the omental flap in adult moyamoya disease. Especially in a patient who is in need of vascular reconstruction of an extensive ischemic area, serratus anterior muscle flap transfer is one of the alternative methods.
